Occurrence of post traumatic stress symptoms and their relationship to professional quality of life (ProQoL) in nursing staff at a forensic psychiatric security unit: a cross-sectional study

Background: Violence is frequent towards nurses in forensic mental health hospitals. Implications of this high risk environment have not been systematically explored. This paper explores occurrence of symptoms on post traumatic stress and their relationship to professional quality of life. Methods: Self report questionnaires assessing symptoms of post traumatic stress and professional quality of life were distributed among psychiatric nurses in a high security forensic psychiatric unit with high frequency of violent behaviour. Relationships between post traumatic stress symptoms, forensic nursing experience, type of ward and compassion satisfaction, burnout and compassion fatigue were explored. Results: The prevalence of post traumatic stress symptoms was low. Low scores were found on compassion satisfaction. Length of psychiatric nursing experience and low scores on compassion satisfaction were correlated to increased post traumatic stress symptoms. Conclusion: Although high violence frequency, low rate of post traumatic stress symptoms and low compassion satisfaction scores was found. High staff/patient ratio and emotional distance between staff and patients are discussed as protective factors.© 2009 Lauvrud et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Paternalism versus autonomy – are we barking up the wrong tree?

SummaryWe explore whether we can reduce paternalism by increasing patient autonomy. We argue that autonomy should not have any automatic priority over other ethical values. Thus, balancing autonomyv.other ethical pillars and finding the optimal balance between the patient's wishes and those of other relevant stakeholders such as the patient's family has to be dynamic over time.</jats:p

Occurrence of post traumatic stress symptoms and their relationship to professional quality of life (ProQoL) in nursing staff at a forensic psychiatric security unit: a cross-sectional study

Background: Violence is frequent towards nurses in forensic mental health hospitals. Implications of this high risk environment have not been systematically explored. This paper explores occurrence of symptoms on post traumatic stress and their relationship to professional quality of life. Methods: Self report questionnaires assessing symptoms of post traumatic stress and professional quality of life were distributed among psychiatric nurses in a high security forensic psychiatric unit with high frequency of violent behaviour. Relationships between post traumatic stress symptoms, forensic nursing experience, type of ward and compassion satisfaction, burnout and compassion fatigue were explored. Results: The prevalence of post traumatic stress symptoms was low. Low scores were found on compassion satisfaction. Length of psychiatric nursing experience and low scores on compassion satisfaction were correlated to increased post traumatic stress symptoms. Conclusion: Although high violence frequency, low rate of post traumatic stress symptoms and low compassion satisfaction scores was found. High staff/patient ratio and emotional distance between staff and patients are discussed as protective factors

Regional development planning and green structure : a study of the green wedges in the county of Stockholm

The aim of the thesis is to analyze the role of regional development planning concerning a regional perspective of green structure and to reflect on its future role. The target group of the study is foremost practitioners but also students of regional planning and development. Three questions are examined. 1) What view concerning green structure has the regional planning body of Stockholm County Council (RTK) communicated through the years? 2) Has this view contributed to generating a common understanding concerning green structure among the actors in the county? 3) Has this common understanding been referred to by actors in discussions concerning how this green structure should develop? The empirical material consists of documents from rtk, the County Administrative Board, the municipalities of the county, a network of ngo:s, as well as interviews with representatives from the above mentioned organizations. The analysis is based on two theoretical perspectives concerning the power regional planning development can exercise; power through consensus and power in situations of dissonance. The results show that RTK for several years has communicated that the regional green structure consists of ten green wedges (kilar); Angarn-, Bogesunds-, Nacka-Värmdö-, Tyresta-, Hanveden-, Bornsjö-, Ekerö-, Görväln-, Järva- and Rösjökilen. The wedges are marked on maps in the regional development plan and in reports of green structure. The view of green structure as consisting of the green wedges was found among a majority of the studied actors; in written documents and confirmed in interviews with representatives of the organizations. A majority of the actors has adopted the vision of the green wedges. All of the interviewees also give examples of how this shared view of green structure has been referred to in discussions among actors in the county. In conclusion, the regional development planning has contributed to generating a common vision of regional green structure in the county. Thus, power through consensus has been exercised. Power in situations of dissonance has also occurred, since actors have referred to the green wedges in discussions among them concerning how the regional green structure should develop. Finally. From a regional point of view, a shared vision of regional green structure can convey a platform where actors meet, which can help the delicate work of balancing green structure and other interests in regional development planning. From an individual point of view, a shared regional vision of green structure can be helpful in implementation situations, when weighing green structure to other dimensions of planning. In Sweden of today a regional perspective of green structure is conveyed in the county of Stockholm and in Scania, but there are several other regional organizations that could work with regional green structure in the future. In the past few years the role of regional sustainable development and nature conservation has gained increased attention in national politics, a promising trend for the future.Syftet med studien är att analysera vilken roll regional utvecklingsplanering haft vad gäller att främja ett regionalt perspektiv på grönstruktur och att reflektera kring den regionala planeringens / utvecklingens framtida roll. Studien vänder sig framförallt till yrkesverksamma men även till studenter inom området regional planering, regional utveckling och samhällsplanering. Tre frågor undersöks. 1) Vilket budskap har Stockholms läns landstings regionplaneorgan förmedlat vad gäller grönstruktur? 2) Har detta budskap bidragit till att generera en regional samsyn hos länets aktörer gällande regional grönstruktur? 3) Hänvisar aktörer i länet till den regionala samsynen vid diskussioner sinsemellan om den regionala grönstrukturens utveckling? Undersökt material är skrifter från Regionplane- och trafikkontoret (RTK), Länsstyrelsen i Stockholms län och ett nätverk med ideella organisationer samt kommunala översiktsplaner, kompletterat av intervjuer med verksamma från de ovan nämnda organisationerna. Två teoretiska perspektiv användes vid analys av det empiriska materialet. Det ena belyser den makt regional utvecklingsplanering kan medföra då aktörer är oeniga och det andra då aktörerna är samstämmiga. Resultatet från studien visar att RTK sedan mitten av nittiotalet kommunicerat att den regionala grönstrukturen består av de tio gröna kilarna Angarn-, Bogesunds-, Nacka-Värmdö-, Tyresta-, Hanveden-, Bornsjö-, Ekerö-, Görväln-, Järva- och Rösjökilen vilka geografiskt avgränsats i regionala kunskapsunderlag och i den regionala utvecklingsplanen. Detta budskap står att återfinna i skrifter och vid intervjuer hos majoriteten av de studerade aktörerna, vilka är centrala i arbetet med regional grönstruktur. Samtliga av de intervjuade ger även exempel på hur de hänvisat till RTK:s budskap vid diskussioner med andra organisationer i länet. Dragna slutsatser är att den regionala utvecklingsplaneringen bidragit till att generera en regional samsyn, en gemensam målbild, kring länets regionala grönstruktur. Detta är påverkan som den regionala utvecklingsplaneringen medfört genom samstämmighet. Samsynen har även omsatts i handling då aktörer hänvisat till målbilden vid diskussioner sinsemellan. Detta är påverkan som aktörer kan utöva vid oenighet. Till sist. Ur ett regionalt perspektiv kan en regional samsyn kring grönstruktur medföra en gemensam plattform för aktörer att mötas på, vilket kan underlätta avvägningar mellan grönstruktur och andra intressen. Ur individens perspektiv kan regionala kunskapsunderlag vid en genomförandesituation vara till stöd vid argumentation om avvägningar mellan olika dimensioner. I Stockholmsregionen och Skåne bedrivs idag regional planering / utveckling vad gäller grönstruktur, men det finns fler regionala organisationer som skulle kunna verka för ett regionalt perspektiv på grönstruktur framöver. Utöver länsstyrelserna finns såväl regionala självstyrelseorgan som kommunala samverkansorgan och informella regionala samarbeten. De senaste åren har den regionala nivån fått allt större uppmärksamhet vad gäller hållbar utveckling och naturvård i den nationella politiken, något som bådar gott inför framtiden

Self-injurious behavior in people with intellectual disabilities and co-occurring psychopathology using the Self-Harm Scale:A pilot study

Self-injurious behavior (SIB) is one of the most detrimental behaviors for the person showing it, as well as for their environment. Nevertheless, structured clinical assessments of SIB are scarce. Staff completed a Self-Harm Scale (SHS) every time they witnessed SIB in clients with an intellectual disability (ID) and co-occurring psychopathology (N = 33). Descriptive statistics were conducted to explore the nature of the incidents of SIB and the characteristics of the people involved in the incidents. In 41 weeks, 104 SIB incidents were reported for 8 out of 33 clients (24%). Incidents were most prevalent on Mondays (23%). As far as the methods of SIB concerned, cutting was the most used method (63%). Clients who showed SIB differed significantly from clients who did not on gender, having a personality disorder and communicative abilities. This study was one of the few that used an incident-based record form to report SIB by direct observation. It is hoped that the SHS helps to gain more information about SIB, to improve individualized interventions. Further research is necessary to determine the psychometric properties and clinical utility of the scale

Aggression on haemodialysis units: a mixed method study

Background Aggression on haemodialysis units is a growing problem internationally that has received little research attention to date. Aggressive behaviour by patients or their relatives can compromise the safety and well-being of staff and other patients sharing a haemodialysis session. Objectives The objectives of the study were twofold: First, to identify the prevalance and nature of aggression on haemodialysis units; and second, to investigate factors that contribute to aggressive behaviour on haemodialysis units. Design and Methods A cross-sectional, sequential mixed method research design was adopted, with two research methods utilised. Incidents of aggressive behaviour were recorded over a 12-month period, using a renal version of the Staff Observation Aggression Scale. Six months after the incident data collection had commenced, semi-structured qualitative interviews were conducted with 29 multidisciplinary members of staff. Results Over 12 months, 74 aggressive incidents were recorded. The majority of incidents involved verbal aggression, and the perpetrators were a minority of patients, relatives and staff. Two patients were responsible for 38% of all incidents; both patients had mental health problems. Distinct temporal patterns to the aggressive behaviour were observed according to the day of the week and time of day. Conclusion This study demonstrates that aggression is a significant problem on haemodialysis units, with verbal aggression most prevalent. The temporal patterns to aggression observed are related to the uniqueness of the haemodialysis setting, with a distinctly different treatment environment compared with other healthcare settings

Personal recovery and its challenges in forensic mental health: systematic review and thematic synthesis of the qualitative literature

Background There has been a call for a framework to guide recovery-oriented practices in forensic mental health services. Aims This study aims to examine personal recovery and its challenges in forensic mental health settings in relation to the established framework for personal recovery in mental illness: connectedness, hope, identity, meaning and empowerment (CHIME). Method This study is an updated and expanded systematic review and thematic synthesis of the qualitative literature. A systematic search of six electronic databases (Web of Science, Medline, PsycINFO, CINAHL, EMBASE and SocIndex) was carried out in January 2019, using the terms [Recover*] AND [Forensic OR Secure] AND [Patient* OR Offend* OR Service User*]. Only studies that included service user's own perceptions and were published from 2014 onward were included in the review. Data were examined with thematic synthesis and subsequently analysed in relation to the CHIME framework. Results Twenty-one studies were included in the review. Findings suggest that some adjustments to the original CHIME framework are needed for it to be more relevant to forensic populations, and that an additional recovery process regarding feeling safe and being secure (safety and security) could be added to CHIME, providing the CHIME-Secure framework (CHIME-S). Specific challenges and barriers for forensic recovery were identified and found to represent the opposite of the recovery processes defined by CHIME (e.g. hopelessness). Conclusions We present the CHIME-S as a framework for the personal recovery processes of forensic mental health service users. The CHIME-S may guide the recovery-oriented work of forensic mental health services.publishedVersio

What´s the Story? Storytelling: Hur skapar man en berättelse för att stärka ett varumärke?

Tiden då en bra produkt sålde sig själv är över. Forskare är överens om att det ökade utbudet av produkter i dagens samhälle har medfört att företagens utmaning numera ligger i att differentiera likartade produkter genom att förvandla dessa till ett koncept eller en livsstil. Värderingar och känslor som ett visst företag symboliserar har blivit viktiga element i denna differentiering. Varumärken är numera mer än bara ett namn och en logotyp och människor konsumerar inte längre en produkt utan ett varumärke och allt vad det står för. Varumärkesbyggande har med andra ord blivit en viktig konkurrensfaktor. Denna uppsats behandlar en typ av varumärkesbyggande som kallas för Storytelling. Syftet med uppsatsen är att öka förståelsen för hur marknadsförare använder storytelling som ett verktyg för att stärka ett varumärke. Vi behandlar inledningsvis den ökade betydelsen av varumärkesbyggande och visar där hur företag genom användandet av storytelling kan uppnå just detta. Därefter följer en presentation av de olika perspektiven inom storytelling och i samband med detta presenterar vi även det teoretiska ramverk som ligger till grund för vår analys. Uppsatsen är utformad som en kvalitativ undersökning där informationsbehovet täcks av djupintervjuer med personer som har lång erfarenhet inom kommunikation och reklambranschen. I intervjuerna ligger fokus på att förstå arbetsgången med att identifiera en berättelse till att sedan kommunicera den. Vi undersöker också i vilken utsträckning som managementbaserade teorier om storytelling kan appliceras i ett marknadsföringssyfte när det gäller varumärkesbyggande. Vi kommer fram till att de managementbaserade teorierna till viss del kan appliceras i ett marknadsföringssyfte men att dessa inte kan tillämpas fullt ut då de olika perspektiven har olika utgångspunkter och syften

Motsvarar första chefsrollen förväntningarna? -16 kvinnliga chefer berättar

Syfte: Syftet med undersökningen är att undersöka om unga högutbildade kvinnors uppfattningar och förväntningar inför första chefsrollen motsvarar den verklighet de möter; samt att kartlägga och diskutera eventuella skillnader och likheter. Metod: Denna studie är baserad på kvalitativ metod. Då vårt empiriska material har samlats in parallellt med sökandet efter teori kan vår ansats liknas vid en abduktiv. Slutsats: Förväntningarna inför första chefsrollen motsvaras sällan av verkligheten. I många fall har bilden av chefskapet varit felaktig. Främst påverkas denna bild av den närmsta omgivningen. Det finns få kvinnliga förebilder vilket medför en onyanserad bild av chefskapet. Den tunga administrativa bördan, avsaknaden av stöd från överordnade samt distansen till medarbetarna är exempel på sådant som förvånade cheferna. Några av cheferna upplever en ensamhet i sin nya roll. Kvinnorna har en inre drivkraft och chefsbefattningen attraherar dem då den ger dem en möjlighet att påverka. Prioriteringarna gällande kombinationen av familj och karriär är en stressfaktor och ett antal av cheferna upplever ett dömande ifrån samhället, i synnerhet ifrån andra kvinnor, på grund av deras prioriteringar. Partnern är ofta chef vilket innebär att det finns en förståelse för varandras arbetsbörda i relationen

Intimate partner violence during COVID-19 lockdown in Norway: the increase of police reports

Background In March 2020, the Norwegian government announced a COVID-19 lockdown in order to reduce the spread of the coronavirus. In Norway, lockdown measures included restricting people’s ability to leave their home and the closing of social institutions, thus reducing the capacity for victims of intimate partner violence to alert someone outside of their home about violent incidents that occurred during lockdown. At the same time, the restrictive measures forced the victim and the perpetrator to stay together for prolonged periods within the home, and reduced the possibility for them to escape or leave the perpetrator. The aim of this study was to investigate how the frequency and character of intimate partner violence reported to the police changed during the period of lockdown in Norway. Methods All cases of intimate partner violence registered in police files before the pandemic (from January 2016-February 2020) and during lockdown in Norway (March-December 2020) were included in the study, representing a total of 974 cases. Differences in the number and severity of cases were calculated using χ2-tests and Wilcoxon’s rank sum test. Differences in the characteristics of the reported violence was assessed with the Brief Spousal Assault form for the Evaluation of Risk (B-SAFER) and tested with Fischer’s exact test with Bonferroni correction. Standardised Morbidity Rate (SMR) statistics were used to analyse the proportion of immigrants as compared to the general population. Results Reported intimate partner violence increased by 54% during the lockdown period in Norway. Between March-December 2020, the police assessed the cases as being at higher risk of imminent and severe violence. Our findings indicated an overrepresentation of immigrant perpetrators before and during lockdown (SMR = 1.814, 95% CI = 1.792–1.836 before, and SMR = 1.807, 95% CI = 1.742–1.872 during lockdown). Notably, while victims with an immigrant background were overrepresented before lockdown, we found significantly lower proportion of immigrant IPV victims during the lockdown period (SMR = 1.070, 95% CI = 1.052–1.087 before, and SMR = 0.835, CI 95% CI = 0.787-0.883 during lockdown). Also, there were significantly more female perpetrators and male victims reported to the police during the lockdown period. A higher proportion of the victims were assessed as having unsafe living conditions and personal problems during lockdown. Finally, during the lockdown period in Norway, a higher proportion of perpetrators had a history of intimate relationship problems. Conclusions Intimate partner violence increased dramatically during the COVID-19 lockdown. A range of options for victims to escape from their perpetrators, particularly during times of crisis, should be developed in line with good practice, and with a special focus on the most vulnerable victims.publishedVersio